Evaluation of esophageal varices on liver computed tomography: Receiver operating characteristic analyses of the performance of radiologists and endoscopists

Background and Aim: Recent liver multi-detector row computed tomography (MDCT) always covers the distal esophagus with an excellent image quality. The aim of this study was to compare the performance of faculty abdominal radiologists with those of radiology residents and endoscopists for the detection of esophageal varices and high-risk esophageal varices on liver MDCT. Methods: A total of 104 cirrhotic patients that had undergone liver MDCT 4 weeks or less before an upper endoscopy were evaluated. Two faculty abdominal radiologists, two radiology residents, and two endoscopists independently interpreted all of the CT images to detect the presence of esophageal varices and high-risk (grade 2 or 3) esophageal varices. With endoscopic grading as the reference standard, their performances were compared by using receiver operating characteristic (ROC) curve analysis. Results: The areas under the ROC curves for the detection of esophageal varices indicated better performance of the abdominal radiologists (A_z = 0.868), compared with the radiology residents (A_z = 0.798) (P = 0.007) and endoscopists (A_z = 0.784) (P = 0.006). For the detection of high-risk esophageal varices, however, the performance of the abdominal radiologists (A_z = 0.914) was similar to those of radiology residents (A_z = 0.900) and endoscopists (A_z = 0.907) (each P > 0.05). Conclusions: Experienced readers have a better ability to detect esophageal varices on liver MDCT, but had no higher performance to evaluate high-risk esophageal varices. As the accuracy of detecting high-risk esophageal varices with clinical relevance on liver MDCT is excellent, even by endoscopists, the evaluation of esophageal varices from a recent liver MDCT may be useful to avoid the use of low-yield endoscopy.